Treatment benefit is a social insurance-based benefit. A person may be entitled to treatment benefits in other EU states. A person from another EU State may qualify for treatment benefit on the basis of social insurance contributions in other EU states. See generally the European Union section in relation to social insurance benefits in the EU.
Treatment benefit is an addition to general, dental, ophthalmic and aural service available from the HSE by medical card holders. See separately in connection with the entitlement to health services.
Treatment benefit covers dental benefit, optical benefit and hearing aids. In some cases, the Department may sanction treatment in another EU state. A prior application and approval is necessary.
Treatment benefit is based on social insurance contributions. The applicant must have paid class A, E, P or H social insurance contributions. Persons under 21 years may qualify with 39 contributions or more. Persons between 21 and 24 require at least 39 contributions paid and at least 39 paid or credited in the governing year and 13 paid in the last contribution year or 26 contributions made in each of the second or third-last contribution years.
In the case of persons between 25 and 66 years of age, they must have 260 paid contributions and at least 39 paid or credited contributions in the governing contribution year i.e. two years earlier and 13 paid in a recent contribution year. Alternatively, they may have 26 paid contributions in each of the second and third last contribution years i.e. two and three years before, respectively.
Persons over 66 years are entitled to treatment benefit if they have paid 260 contributions at any time. At least 39 must be paid or credited in any of the two contribution years before reaching 66 years and 33 paid in a recent contribution year relative to age 66.
There are exceptions for persons who retire prior to 1992 and 1987 respectively. A lower number of contributions sufficed. The recent contribution year rule requires 13 paid contributions in a recent year. This may be the same as the year in which 39 paid or credited contributions have been made and the 13 paid may be the part of the 39. Alternatively, it may be one of the two proceeding years or subsequent year.
Persons who have certain allowances do not require 13 recently paid contributions including long-term illness benefit, state pension transitional, long-term job seeker’s allowance, pre-retirement allowance, a combination of jobseekers benefit and job allowance, invalidity pension.
If a person qualifies at 60, he may retain entitlement for life. If a person between 61 and 65 years does not meet the qualifying conditions of 60 years, he may meet the conditions before 65 years. A spouse, civil partner or co-habitant may qualify in his or her own right. If he/ she does not have sufficient social insurance contributions, he may qualify on the basis of the pension of their spouses, civil partners or co-habitants entitlement, if they are dependent on the latter.
A dependent spouse, civil partner or a cohabitant must
- have a gross income of less than 100 per week.
- Earn more but be dependent before entering or resuming insurable employment
- not get a social welfare payment (except disablement supplementary welfare, child benefit or carer’s benefit.)
- have a carer’s allowance or state non-contributory pension and be dependent on the qualifying person before obtaining the allowance or the benefit.
Under the scheme, the cost of an oral examination once a year is covered. Examination is provided by private dentists on the Departmental panel.
Treatment benefit entitles the qualifying person to a free eyesight test. This does not cover applications for driving licences and certain other sight tests. It is provided by opticians and optometrists under contract with the Department.
The Department pays up to half the cost to a maximum of €500 for prescribed contact lenses. This is only available in respect of contact lenses on medical grounds where wearing glasses are difficult. They are not available on cosmetic grounds nor are temporary lenses covered.
Hearing aids may be provided by suppliers under contract. The Department pays half the cost to a maximum of €500 every five years together with half the cost of repair.
An application is required for dental, optical and aural services. There are different forms which must be completed and returned to the Department of Social Protection office or treatment benefit section. The relevant contribution is two years prior.